Note if there exists more than one secondary

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Note, if there exists more than one secondary diagnosis from the specified diagnosis list for this type of rerouting, then the APR-DRG grouper provides additional selection logic to designate a PDX for grouping purposes. The approach is to select the diagnosis with the highest severity level to capture the PDX that most fully describes the reason for the hospitalization. If there are several secondary diagnoses from the diagnosis list and they have the same severity level, the APR-DRG grouper selects the first one occurring in ICD-9-CM code order. This selection logic also applies to rerouting types 18A, 19A and 20A, which involve resequencing of PDX and SDX for grouping purposes. A6X: PDX and SDX and Medical Æ SDX clarifies PDX and assignment to new MDC and APR-DRG; there is no need to resequence PDX and SDX. If medical patient in MDC 5 (Diseases & Disorders of the Circulatory System) has a PDX of complication of other vascular device, implant and graft and an SDX of renal failure without heart failure, then reassign the patient from MDC 5, APR-DRG 206 Malfunction, Reaction, Complication of Cardiac/Vascular Device or Procedure to MDC 11 (Diseases & Disorders of the Kidney & Urinary Tract), APR-DRG 466 Malfunction, Reaction, Compli- cation of Genitourinary Device or Procedure. A7P: PDX and SDX and whether Surgical or Medical Æ Resequence the PDX-SDX for APR-DRG grouping purposes and assign patient to new MDC and appropriate surgical or medical APR-DRG based upon the hierarchies and logic of the new MDC. If patient in MDC 10 (Endocrine, Nutritional & Metabolic Diseases and Disorders) has a PDX of diabetes manifestation not elsewhere classified and an SDX of osteomyelitis, then for APR-DRG grouping purposes, resequence the PDX-SDX so that osteomyelitis is the PDX and patient is assigned to MDC 8 (Diseases & Disorders of the Musculoskeletal Sys- tem and Connective Tissue) and to the appropriate surgical or medical APR-DRG per MDC 8 logic. If patient in MDC 10 (Endocrine, Nutritional & Metabolic Diseases and Disorders) has a PDX of diabetes manifestation not elsewhere classified and an SDX of skin ulcer, then for APR-DRG grouping purposes resequence the PDX-SDX so that skin ulcer is the PDX and patient is assigned to MDC 9 (Diseases & Disorders of the Skin, Subcutaneous Tis- sue & Breast) and to the appropriate surgical or medical APR-DRG per MDC 9 logic. If a patient in MDC 10 (Endocrine, Nutritional & Metabolic Diseases and Disorders) has a PDX of diabetes manifestation not elsewhere classified and SDXs of both osteomyelitis and skin ulcer, then regroup with osteomyelitis resequenced as the new PDX and assign patient to MDC 8 (Diseases & Disorders of the Musculoskeletal System and Connective Tissue). A8P: PDX and SDX and Only OR Procedure Except Related OR Procedures Æ Resequence the PDX-SDX for APR-DRG grouping purposes and assign patient to new MDC and APR-DRG assignment is made based upon the surgical hierarchy of the new MDC.
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  • Fall '18
  • Diagnosis-related group, DRGs

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